| 1 | Representative Rich offered the following: |
| 2 |
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| 3 | Amendment |
| 4 | Remove lines 703 through 791 and insert: |
| 5 | health care services to all Medicaid recipients in an AHCA area. |
| 6 | Each entity must offer sufficient choice of providers in its |
| 7 | network to ensure recipient access to care and the opportunity |
| 8 | to select a provider with whom they are satisfied. The network |
| 9 | shall include all public mental health hospitals. To ensure |
| 10 | unimpaired access to behavioral health care services by Medicaid |
| 11 | recipients, all contracts issued pursuant to this paragraph |
| 12 | shall require 80 percent of the capitation paid to the managed |
| 13 | care plan, including health maintenance organizations, to be |
| 14 | expended for the provision of behavioral health care services. |
| 15 | In the event the managed care plan expends less than 80 percent |
| 16 | of the capitation paid pursuant to this paragraph for the |
| 17 | provision of behavioral health care services, the difference |
| 18 | shall be returned to the agency. The agency shall provide the |
| 19 | managed care plan with a certification letter indicating the |
| 20 | amount of capitation paid during each calendar year for the |
| 21 | provision of behavioral health care services pursuant to this |
| 22 | section. The agency may reimburse for substance abuse treatment |
| 23 | services on a fee-for-service basis until the agency finds that |
| 24 | adequate funds are available for capitated, prepaid |
| 25 | arrangements. |
| 26 | 1. By January 1, 2001, the agency shall modify the |
| 27 | contracts with the entities providing comprehensive inpatient |
| 28 | and outpatient mental health care services to Medicaid |
| 29 | recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk |
| 30 | Counties, to include substance abuse treatment services. |
| 31 | 2. By July 1, 2003, the agency and the Department of |
| 32 | Children and Family Services shall execute a written agreement |
| 33 | that requires collaboration and joint development of all policy, |
| 34 | budgets, procurement documents, contracts, and monitoring plans |
| 35 | that have an impact on the state and Medicaid community mental |
| 36 | health and targeted case management programs. |
| 37 | 3. By July 1, 2006, the agency and the Department of |
| 38 | Children and Family Services shall contract with managed care |
| 39 | entities in each AHCA area except area 6 or arrange to provide |
| 40 | comprehensive inpatient and outpatient mental health and |
| 41 | substance abuse services through capitated prepaid arrangements |
| 42 | to all Medicaid recipients who are eligible to participate in |
| 43 | such plans under federal law and regulation. In AHCA areas where |
| 44 | eligible individuals number less than 150,000, the agency shall |
| 45 | contract with a single managed care plan. The agency may |
| 46 | contract with more than one plan in AHCA areas where the |
| 47 | eligible population exceeds 150,000. Contracts awarded pursuant |
| 48 | to this section shall be competitively procured. Both for-profit |
| 49 | and not-for-profit corporations shall be eligible to compete. |
| 50 | 4. By October 1, 2003, the agency and the department shall |
| 51 | submit a plan to the Governor, the President of the Senate, and |
| 52 | the Speaker of the House of Representatives which provides for |
| 53 | the full implementation of capitated prepaid behavioral health |
| 54 | care in all areas of the state. The plan shall include |
| 55 | provisions which ensure that children and families receiving |
| 56 | foster care and other related services are appropriately served |
| 57 | and that these services assist the community-based care lead |
| 58 | agencies in meeting the goals and outcomes of the child welfare |
| 59 | system. The plan will be developed with the participation of |
| 60 | community-based lead agencies, community alliances, sheriffs, |
| 61 | and community providers serving dependent children. |
| 62 | a. Implementation shall begin in 2003 in those AHCA areas |
| 63 | of the state where the agency is able to establish sufficient |
| 64 | capitation rates. |
| 65 | b. If the agency determines that the proposed capitation |
| 66 | rate in any area is insufficient to provide appropriate |
| 67 | services, the agency may adjust the capitation rate to ensure |
| 68 | that care will be available. The agency and the department may |
| 69 | use existing general revenue to address any additional required |
| 70 | match but may not over-obligate existing funds on an annualized |
| 71 | basis. |
| 72 | c. Subject to any limitations provided for in the General |
| 73 | Appropriations Act, the agency, in compliance with appropriate |
| 74 | federal authorization, shall develop policies and procedures |
| 75 | that allow for certification of local and state funds. |
| 76 | 5. Children residing in a statewide inpatient psychiatric |
| 77 | program, or in a Department of Juvenile Justice or a Department |
| 78 | of Children and Family Services residential program approved as |
| 79 | a Medicaid behavioral health overlay services provider shall not |
| 80 | be included in a behavioral health care prepaid health plan |
| 81 | pursuant to this paragraph. |
| 82 | 6. In converting to a prepaid system of delivery, the |
| 83 | agency shall in its procurement document require an entity |
| 84 | providing comprehensive behavioral health care services to |